ENGROSSED
COMMITTEE SUBSTITUTE
FOR
H. B. 2431
(By Mr. Speaker, Mr. Kiss, and Delegates
Williams, Douglas,
Fleischauer,
Compton,
Pettit
and Warner)
(Originating in the Committee on Government Organization)
[April 1, 1997]
A BILL to amend and reenact section four, article twenty-four;
section six, article twenty-five; and section twenty-four,
article twenty-five-a, all of chapter thirty-three of the code
of West Virginia, one thousand nine hundred thirty-one, as
amended; and to further amend said chapter by adding thereto
a new article, designated article forty-one, all relating to
women's access to health care; enacting the "Women's Access To
Health Care Act"; defining terms; stating legislative findings
and purpose; requiring providers of health benefits policies
to provide coverage for direct access to women's health care
providers and specified services without referral; permitting
advanced practice nurses to serve in the capacity of primary
care physicians.
Be it enacted by the Legislature of West Virginia:
That section four, article twenty-four; section six, article twenty-five; and section twenty-four, article twenty-five-a, all of
chapter thirty-three of the code of West Virginia, one thousand
nine hundred thirty-one, as amended, be amended and reenacted; and
that said chapter be further amended by adding thereto a new
article, designated article forty-one, all to read as follows:
CHAPTER 33. INSURANCE.
ARTICLE 24. HOSPITAL SERVICE CORPORATIONS, MEDICAL SERVICE
CORPORATIONS, DENTAL SERVICE CORPORATIONS AND
HEALTH SERVICE CORPORATIONS.
§33-24-4. Exemptions; applicability of insurance laws.
Every corporation defined in section two of this article is
hereby declared to be a scientific, nonprofit institution and
exempt from the payment of all property and other taxes. Every
corporation, to the same extent the provisions are applicable to
insurers transacting similar kinds of insurance and not
inconsistent with the provisions of this article, shall be governed
by and be subject to the provisions as hereinbelow indicated, of
the following articles of this chapter: Article two (insurance
commissioner), except that, under section nine of said article,
examinations shall be conducted at least once every four years;
article four (general provisions), except that section sixteen of
said article shall not be applicable thereto; section thirty-four,
article six (fee for form and rate filing); article six-c
(guaranteed loss ratio); article seven (assets and liabilities); article eleven (unfair trade practices); article twelve (agents,
brokers and solicitors), except that the agent's license fee shall
be five dollars; section fourteen, article fifteen (individual
accident and sickness insurance); section sixteen, article fifteen
(coverage of children); section eighteen, article fifteen (equal
treatment of state agency); section nineteen, article fifteen
(coordination of benefits with medicaid); article fifteen-a
(long-term care insurance); article fifteen-c (diabetes insurance);
section three, article sixteen (required policy provisions);
section three-a, article sixteen (mental illness); section three-c,
article sixteen (group accident and sickness insurance); section
three-d, article sixteen (medicare supplement insurance); section
three-f, article sixteen (treatment of temporomandibular joint
disorder and craniomandibular disorder); section eleven, article
sixteen (coverage of children); section thirteen, article sixteen
(equal treatment of state agency); section fourteen, article
sixteen (coordination of benefits with medicaid); section sixteen,
article sixteen (diabetes insurance); article sixteen-a (group
health insurance conversion); article sixteen-c (small employer
group policies); article sixteen-d (marketing and rate practices
for small employers); article twenty-six-a (West Virginia life and
health insurance guaranty association act), after the first day of
October, one thousand nine hundred ninety-one; article twenty-seven
(insurance holding company systems); article twenty-eight (individual accident and sickness insurance minimum standards);
article thirty-three (annual audited financial report); article
thirty-four (administrative supervision); article thirty-four-a
(standards and commissioner's authority for companies deemed to be
in hazardous financial condition); article thirty-five (criminal
sanctions for failure to report impairment); and article
thirty-seven (managing general agents); and article forty-one
(women's access to health care); and no other provision of this
chapter may apply to these corporations unless specifically made
applicable by the provisions of this article. If, however, the
corporation is converted into a corporation organized for a
pecuniary profit or if it transacts business without having
obtained a license as required by section five of this article, it
shall thereupon forfeit its right to these exemptions.
ARTICLE 25. HEALTH CARE CORPORATIONS.
§33-25-6. Supervision and regulation by insurance commissioner;
exemption from insurance laws.
Corporations organized under this article are subject to
supervision and regulation of the insurance commissioner. The
corporations organized under this article, to the same extent these
provisions are applicable to insurers transacting similar kinds of
insurance and not inconsistent with the provisions of this article,
shall be governed by and be subject to the provisions as
hereinbelow indicated of the following articles of this chapter: Article four (general provisions), except that section sixteen of
said article shall not be applicable thereto; article six-c
(guaranteed loss ratio); article seven (assets and liabilities);
article eight (investments); article ten (rehabilitation and
liquidation); section fourteen, article fifteen (individual
accident and sickness insurance); section sixteen, article fifteen
(coverage of children); section eighteen, article fifteen (equal
treatment of state agency); section nineteen, article fifteen
(coordination of benefits with medicaid); article fifteen-c
(diabetes insurance); section three, article sixteen (required
policy provisions); section eleven, article sixteen (coverage of
children); section thirteen, article sixteen (equal treatment of
state agency); section fourteen, article sixteen (coordination of
benefits with medicaid); section sixteen, article sixteen (diabetes
insurance); article sixteen-a (group health insurance
conversion); article sixteen-c (small employer group policies);
article sixteen-d (marketing and rate practices for small
employers); article twenty-six-a (West Virginia life and health
insurance guaranty association act); article twenty-seven
(insurance holding company systems); article thirty-three (annual
audited financial report); article thirty-four-a (standards and
commissioner's authority for companies deemed to be in hazardous
financial condition); article thirty-five (criminal sanctions for
failure to report impairment); and article thirty-seven (managing general agents); and article forty-one (women's access to health
care); and no other provision of this chapter may apply to these
corporations unless specifically made applicable by the provisions
of this article.
ARTICLE 25A. HEALTH MAINTENANCE ORGANIZATION ACT.
§33-25A-24. Statutory construction and relationship to other laws.
(a) Except as otherwise provided in this article, provisions
of the insurance laws and provisions of hospital or medical service
corporation laws are not applicable to any health maintenance
organization granted a certificate of authority under this article.
The provisions of this article shall not apply to an insurer or
hospital or medical service corporation licensed and regulated
pursuant to the insurance laws or the hospital or medical service
corporation laws of this state except with respect to its health
maintenance corporation activities authorized and regulated
pursuant to this article. The provisions of this article shall not
apply to an entity properly licensed by a reciprocal state to
provide health care services to employer groups, where residents of
West Virginia are members of an employer group, and the employer
group contract is entered into in the reciprocal state. For
purposes of this subsection, a "reciprocal state" means a state
which physically borders West Virginia and which has subscriber or
enrollee hold harmless requirements substantially similar to those
set out in section seven-a of this article.
(b) Factually accurate advertising or solicitation regarding
the range of services provided, the premiums and copayments
charged, the sites of services and hours of operation, and any
other quantifiable, nonprofessional aspects of its operation by a
health maintenance organization granted a certificate of authority,
or its representative shall not be construed to violate any
provision of law relating to solicitation or advertising by health
professions: Provided, That nothing contained in this subsection
shall be construed as authorizing any solicitation or advertising
which identifies or refers to any individual provider or makes any
qualitative judgment concerning any provider.
(c) Any health maintenance organization authorized under this
article shall not be considered to be practicing medicine and is
exempt from the provisions of chapter thirty of this code, relating
to the practice of medicine.
(d) The provisions of section fifteen, article four (general
provisions); section seventeen, article six (noncomplying forms);
article six-c (guaranteed loss ratio); article seven (assets and
liabilities); article eight (investments); article nine
(administration of deposits); article twelve (agents, brokers,
solicitors and excess line); section fourteen, article fifteen
(individual accident and sickness insurance); section sixteen,
article fifteen (coverage of children); section eighteen, article
fifteen (equal treatment of state agency); section nineteen, article fifteen (coordination of benefits with medicaid); article
fifteen-b (uniform health care administration act); section three,
article sixteen (required policy provisions); section three-f,
article sixteen (treatment of temporomandibular disorder and
craniomandibular disorder); section eleven, article sixteen
(coverage of children); section thirteen, article sixteen (equal
treatment of state agency); section fourteen, article sixteen
(coordination of benefits with medicaid); article sixteen-a (group
health insurance conversion); article sixteen-c (small employer
group policies); article sixteen-d (marketing and rate practices
for small employers); article twenty-seven (insurance holding
company systems); article thirty-four-a (standards and
commissioner's authority for companies deemed to be in hazardous
financial condition); article thirty-five (criminal sanctions for
failure to report impairment); article thirty-seven (managing
general agents); and article thirty-nine (disclosure of material
transactions); and article forty-one (women's access to health
care) shall be applicable to any health maintenance organization
granted a certificate of authority under this article. In
circumstances where the code provisions made applicable to health
maintenance organizations by this section refer to the "insurer",
the "corporation" or words of similar import, the language shall be
construed to include health maintenance organizations.
(e) Any long-term care insurance policy delivered or issued for delivery in this state by a health maintenance organization
shall comply with the provisions of article fifteen-a of this
chapter.
(f) A health maintenance organization granted a certificate of
authority under this article shall be exempt from paying municipal
business and occupation taxes on gross income it receives from its
enrollees, or from their employers or others on their behalf, for
health care items or services provided directly or indirectly by
the health maintenance organization. This exemption applies to all
taxable years through the thirty-first day of December, one
thousand nine hundred ninety-six. The commissioner and the tax
department shall conduct a study of the appropriations of
imposition of the municipal business and occupation tax or other
tax on health maintenance organizations, and shall report to the
regular session of the Legislature, one thousand nine hundred
ninety-seven, on their findings, conclusions and recommendations,
together with drafts of any legislation necessary to effectuate
their recommendations.
ARTICLE 41. WOMEN'S ACCESS TO HEALTH CARE ACT.
§33-41-1. Short title.
This article may be known and shall be cited as the "Women's
Access To Health Care Act."
§33-41-2. Definitions.
For purposes of this article:
(1) "Advanced nurse practitioner" means a certified nurse- midwife, or an advanced nurse practitioner certified to practice in
family practice, women's health (ob/gyn), or primary care adult,
geriatric or pediatric practice, practicing within the lawful scope
of that provider's practice.
(2) "Health benefit policy" means any individual or group plan,
policy or contract for health care services issued, delivered,
issued for delivery, or renewed in this state by a health care
corporation, health maintenance organization, accident and sickness
insurer, fraternal benefit society, nonprofit hospital service
corporation, nonprofit medical service corporation or similar
entity, when the policy or plan covers hospital, medical or
surgical expenses.
(3) "Women's health care provider" means an
obstetrician/gynecologist, pussyadvanced nurse practioner certified to
practice in wonemens''s health (ob/gyn) or certified nurse-midwife
practicing within the lawful scope of that provider's practice.
§33-41-3. Legislative findings and purpose.
The Legislature finds and declares that adequate delivery of
health care services to women requires direct access to primary and
preventative obstetrical and gynecological services, which services
may be provided as "well woman examinations," and direct access
without prior authorization to prenatal and obstetrical services
for pregnant women. The Legislature further finds that the services of advanced nurse practitioners providing essential
preventive, obstetrical and primary care, especially to
economically disadvantaged women in rural and medically underserved
areas of the state, have resulted in improved health status
indicators for this state, especially indications that newborn
infants are healthier; and that any curtailment in the availability
of those services as health delivery systems develop and change
would have a disparate, adverse effect on the health of women.
§33-41-4. Limitations on conditions of coverage.
No health benefits policy may require as a condition to the
coverage of basic primary and preventative obstetrical and
gynecological services that a woman first obtain a referral from a
primary care physician: Provided, That direct access, at least
annually, to a women's health care provider for purposes of a well
woman examination shall satisfy the foregoing requirement. No
health benefits policy may require as a condition to the coverage
of prenatal or obstetrical care that a woman first obtain a
referral for those services by a primary care physician. No
health benefits policy may require as a condition to the coverage
of basic primary or preventive services provided by an advanced
nurse practitioner may require as a condition to the coverage that
an enrollee, subscriber or insured first obtain a referral for
those services by a primary care physician: Provided hovwever, That
this limitation does not apply to a health benefit policy that
permits an enrollee, subscriber or insured to select an advanced
nurse practitioner as the primary care physician in accordance with section five of this article.
§33-41-5. Women's health care provider and advanced nurse
practitioners as primary care physicians.
Notwithstanding the provisions of article twenty-five-a of this
chapter, a health maintenance organization may permit an enrollee,
subscriber or member to select a woman's health care provider or an
advanced nurse practitioner to serve in the capacity of the
subscriber's primary care physician responsible for coordinating
the health care of the subscriber. A health maintenance
organization that elects to permit a woman's health care provider
or advanced nurse practitioner to serve in the capacity of the
primary care physician may require that a woman's health care
provider or advanced nurse practitioner have written practice
agreements with a collaborating primary care physician for services
outside the scope of the provider's practice. Nothing in this
article is intended to expand the scope of practice of an advanced
nurse practitioner as defined in article seven, chapter thirty of
this code or the scope of practice of a certified nurse-midwife as
defined in article fifteen of chapter thirty. Except for the
specific limitations in section four of this article, nothing in
this article is intended to limit the powers of health maintenance
organizations with respect to entering into contracts or developing
criteria for credentialing providers consistent with the provisions of article twenty-five-a of this chapter.